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11532 SW COLE LANE r Sa��'Taey frwer J�[, Z 7 7 G EL 27y, 7S l Z Sk,,i e7,,le La."l - E L Z 7 e / /kt�fcr 0✓a 'PIS �D^"c dri trt 4eS ��N i d -t-r,a 0 EL Z 76 -vc.k. *Z,5_110 r3.,4°- LF vR �P6 S . W. COLE l_ E S8910'0 "W =40. 1 E� Z73. 75 S'Sr/7,90voa 04,01e CGNglr'✓A►�►N �w+/ll'��i1) � �0• 1 'f'L:X 3.61 ' 1 �. X1640+ '20 2 N N 0 • 0 k&4 e 9 a, EROSION OONTW (n I' ; , . ,, � .` � . , � ,�I �� 1. PROVIDE b MAINTAIN 8'(min) TMCK GRAVEL PAD & DF1;VE UNTIL PERivIANENT C3 116.7' p7 2'0 •, . 21. , .�-�arw, p 'Hs CONCf�ETE DRP)E IS IN P!.A, o NI b I 9.3' `n I c� 12.0' ,f�k�t Et I p ' Z ' i' ' "'"'= MAINTAIN SOIL SEDIMENT c �ti �Lj- .Sewrr M i GF Z 7y's FEN(;E AS INDICATED. Z 7 7. 5' p f n I O -- --------� FF ' 12.00' NOTE: CENTERLINE CONCEPT g'S I SURVEYORS, WILL PIN ALL EXTERIOR l .o �"— 16 , FOUNDATION CORNERS AND PROVIDE .00' N I SUBSEQUENT MORTGAGE SURVEY. I 38. 0' 0 I I A (J� O B PUBLIC STORM DRAINAG- -4 EASEMENT Q --REVISE HOUSE TO GARAGE LEFT PER TRAVIS, N8910'00 E 83.28 x/2/99, MPW. EL ?73.5 EL z,` SCALE DRAWIN& LOT 6, EVERGREEN SPRINGS ELZ�7, 9El 178 EC z7y N.W. 1/4 SEC.10,T,2S.,R.1 W., W.M. --AN 8 FOOT WIDE PUBLIC UTILITY EASEMENT .Sf oil D�.-'.�A�e CITY OF TIGARD SHALL EXIST ALONG ALL STREET FRONTAGE r!a��ial — EL ZG7 WASHINGTON COUNTY, OREGON JANUARY 27, 1999 Centerline C,� On cue is Inc . DRAWN BY: PDS CHECKED BY: WGDIII P SCALE 1 "=20' ACCOUNT 1 640 82nd Drive Gladstone, Oregon 97027 M: \M[.l\PLAT\EVERGS\L6EVERGS 503 650-0188 fax 503 650-0199 NOTICE: IF THE PRINT OR TYPE ON ANY Fl.[� II � I ( ► II ( 1 ( I � ( lI I ( ! I (T 111 Ill III I-�7 f1 tlTcz 12 FT IIIlil III III ! II 1111-1­11-111'T11-IJT f I I I I I I I � ( I II1 I IIII r1 I I IMAGE SNOT AS CLEAR AS THIS NOTICE, 1 2 � 4 I ( + ,'_7 �_ � IT IS DUE TO THE QUALITY OF THE _ - - - --- p _ N0.3V ��.er.wan- 89 �Ma+rcorr ORIGINAL DOCUMENTT__ -� - _ --�8Z 9Z 5Z � Z EZ Z TZ OZ 6i 81 LT 9T ST fiT ET ZT TI T 6 - 8 L 9 9 E Z T ��ai;lw II11 IIII Illi II!I Illl�!III I1IIIIIII IIII IIII ILII 1111111 lel{ 1�1.1111L111! ILII. IIII 1111 1!1 11111 IIII 11111111 Ill1111" 1111191 1111 IIII 11111111111111111111 IIII 11111111 11!11111 fill ll 1111 Lll 1111 LII! 111 11.11 it II to w N N n O r m z m i i i I 11532 SW COLE LANE CERTIFICATE OF OCCUPANCY CITY OF T I GA R D DEVELOPMENT SERVICES DATE S UIED: 2/22/1199955 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 PARCEL: 2S11013A-08100 ZONING: R-4.5 JURISDICTION: TIG SITE ADDRESS: 11532 SW COLE LN FILE SUBDIVISBLOCION: EVERGREEN SPRINGSLOT:006 COPY CLASS OF WORK: NEW TYPE OF USE: SF TYPE OF CONSTR: 5N OCCUPANCY GRP: R3 TENANT NAME: REMARKS: Single family detached, Path 1 Final Building Inspection avid Certificate of Occupancy Approved 11/18/99 by George Steele, Building Inspector Owner: RENAISSANCE DEVELOPMENT 1672 SW WILLAMETTE FALLS DR WEST LINN, OR 97068 Phone: Contractor: RENAISSANCE CUSTOM HOMES 1672 WILLAMETTE FALLS DR WEST LINN, OR 97068 Phone: 557-8000 Reg#: This Certifici.te grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the State of Oregon Specialty Codes for the group, occupancy, and use under which the referenced permit was issued. BUILDING INSPL@CTOR BUILDING OFFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 I�MST 1 �; BUP Date Requested AM _PM BLD Location //`��S w Suite . L e MEC Contact Person Ph '� PLM /7�"• ' z Contractor Ph SWR �UILDI Tenant/Owner _ ELC Retaining Wall ELR _ Footing Access: Foundation FPS Ftg Drain — Crawl Drain Inspection Notes: SGN Slab Post& Beam SIT Fxt Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling — Roof -y--- 1! ART FAI! UMBING Post&Beam --- __.___--- ---- -- Under Slab Top Out Water Service Sanitary Sewarr R rains 11115�S—S]ilPART FAIL - l" ` 9 MECHANICAL Post $ Beam Rough In Gas Line ---- Smoke Dampers Final - --- ART FAIL ft&CTRIQSV -_- Service Rough In _ UG/Slab Low Voltage 1 ire Alarm PART FAIL SITE Backfill/Grading --- - Sanitary Sewer Storm Drain [ ]Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( J Please call for reinspection RE: -_ _ [ j Unable to inspect-no access ADA Approach/Sidewalk Other _ Date _f/-� _Inspector 1! �_a_ Ext Final PASS PART FAIL 00 NOT' REMOVE this inspection record from the job site.. CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: P /24/19 -00302 1 11 L" k 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 09/24/1999 PARCEL: 2S 110BA-08100 SITE ADDRESS: 11532. SW COLE LN SUBDIVISION: EVERGREEN SPRINGS ZONING: R-4.5 BLOCK: LOT: 006 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Residential backflow prevention device _ FEES _ Owner: Type By Date Amount Receipt RENAISSANCE CUSTOM HOMES PRMT KJP 09/24/199E $25.00 99-318594 1672 SW WILLAMETTE FALLS DR 5PCT KJP 09/24/1995 $1.75 99-318594 WEST LINN, OR 97068 Total $26.75 Phone 1: 557-8000 Contractor: MOODY ENTERPRISE INC PO BOX 98 ESTACADA, OR 97023 REQUIRED INSPECTIONS RP/Backflow Preventer Phone 1: 631-2918 Final Inspection Reg #: LIC 00005973 PLM 11717 ORIGINAL. This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: ��� �� Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day T-Y OF TIGARD Plumbing Application Redd By�1 :125 W HALL BLVD. Commercial and Residential Dot.R.c'd GARD, OR 97223 oats to P.E. :03) 639-4171 %�h `� Date to DSTpermit 0 L7-Ll I -"' Print or Type Related SWR! Incomplete or illegible applications will not be accepted called Name of OsvelopmentfProled FUCTUR_ES;(Indlvldwl) ;i .Job rill CiZ� P�'i/�J- i � �''S ��r Sink 0.00 Address SU"tLavU Add s9 Swte ory 900 j_ Z S < L Tub or TublShower Comb.- 9.00 Bldg! City/Slate p -. Shower On t I f , c, ,�Z ' Water closet 9.00 Nr ,/ 9.00 „,e A,01 f i-c ,e�V CG oIt ITVM ee' Dlshhwasher 9.00 Owner M�htt�p / / Suits Garbage-am 9.00 tL Waging mechins 9.00 IS is lip PV�� Floor Drain F4' U 97v tl.00Nam. a.00 9.00 Occupant Marg Addntss suite Water t•Nalsr 9.00 Laundry Room Tray 9.00 ClryfStete Zip Phone Urinal 9.00 [ANT / ` Other Fbmsm(Spsafy) 9.00 fJf ��lt'it P '. N 9.00 Contractor Ma'Wh9 Suits 9 c7. (Prior to issuance Coy tate Phone 9.00 aPPlkant roust _,.! r O QZ bJ~' 7 q 1,y 9.00 provide a9 Oregon ConaL Cont.Board Uc.! Date 9.00 aMlrattors �� OQ ken" Plumbing Ur-! Exp.Oils 9.00 information `� r-tet too' for COT COT Business Tax or Metro! Dat Sewer-each addiflonal 1 ar Z5.00 database). J'(1 G(J' Water SeMcal-1911 1c0' 30.00 Pta►ne Water Service-each addlf vl 200' 25.00 Architect Storm a Reith Oran-let lar 30.00 or Mang Address Suite Storm a Pain Drain-each additional lar 25.00 MollmM Homs Space 25.00 Engineer City/State zip Phone Cormwrpal Baric Flow Pmwnbon Device or Anti. 25.00 Pollution Oevke esambe worn Now Addybn O Alfsraton O Repair O Reshdentli l Baddlow Prsveridon Device, 15.00 be done: Res orftl m/ Non-residentlal O Wdmbonal doscrtpoon of worth Any Trap or Waste Not Connected to a Fixture 9.00 Catch Basin 9.00 If� le Insp.of Eads"Plumping 40.00 skfl nng use of l G dw Specialty Requr.ted Inspections 40.00 kling or property parte Rain Drain,single family dweUng 30.00 nosed use of Grease Traps 9.00 ding or property you appng, ma DUANTnY TOTAL itt_' vi�g or rePlaan9 any fbcturcs7! YesC] No❑ Iwrmeetc a mar dhgram is nw.td/Doam+ay Total is �9 ? , (��k _y"sae beck of form) 'SUBTOTAL -reby acknowledge that I have read this applkeUon,that the information _ i '• 'n.s carred,that I am the owner or authorized agent of the owner,and 5%SURCHARGE -fans submitted are in compliance with O on State Laws. a of A�ent pa PLAN REVIEW 25X OF SUBTOTAL _ r Dot* e ' { �/,/ //�� (th 4re vr�total is>_9 - _D�UL��,t�����//lll � /�G(/ / 1 TOTAL ,,uct Person Name k3 IC4 {� t / 7/v Z 'Minimum permit fee is$25• 5%surcharge.except Resrden"BaCdlew L GI _ L7 J Prevention Device.which is S15+5%surcharge L\plrnapp.doc 12'96 (dst) CITY 4F TIGARD MASTER F,E:RMIT DEVELOPMENT SERVICES FIERMIT #. . . . . . . : MST99--0055 13125 S V Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 02/22/99 FIARCEL: 2S 1 100A--08100 SITE ADDRESS. . . : 1. 1.532 SW COLE LN SUBDIVISION. . . . :EVERGREEN SPRINGS ZONING: R-4. 5 BU_OCHl,. . . . . . . . . . LOT. . . . . . . . . . . . . :006 JURISDICTION: TIG Remarks: Single family detached, Path 1. -------------------------------------------------------------- BUILDING ---------------------------—- -- —— -——------------- REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED------------- CLASS OF WORK.:NEW HEIGHT.,......: 20 FIRST....: 1098 sf GARAGE.....: 774 sf LEFT..........: 16 SMOKE DETECTRS: Y TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1276 sf FRONT.........: 20 PARKING SPACES: 2 TYPE OF CONST.:SN DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 15 OCCUPANCY GRP.:R3 BDRM: 4 BATH: 3 TOTAL------: 2374 sf VALUE..$: 180508 REAR..........: 34 --------------------------------------------------------------- PLUMBING ---—---------------- ----------------- SINKS.........: I WATER CLOSETS.: 3 WASHING MACH..: I LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 100 TRAPS.........: 0 LAVATORIES....: 4 DISHWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LIFE ft: 100 SF RAIN DRAINS: 1 CATCH BASINS..: 0 TUB/SHOVERS...: 3 GARBAGE DISP..: 1 WATER HEATERS.: 1 WATER LINE ft: 110 BCKFLW PREVNTR: 1 GREASE TRAPS,.: 0 OTHER FIXTURES: 0 -----------------..-..-------------------------------------------- MECHANICAL ------------ FUEL. TYPES------------ FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1 GAS FURN )=100K ..: l UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1 MAX INP.: 1 BTU FLOOR FURNACES: 0 VENTS......,..: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1 ------------------------------------------------------------------- ELECTRICAL --------------- - --RESIDENTIAL UNIT--- ---SERVICE/FEEDER----- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-- IM SF OR LESS: l 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 HER INSPECTION: 0 EA ADD'1. 501SF.: 5 201 - 400 amp..: 0 201 - 400 amp..: 0 lst W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR....,.: 0 LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGUX/PANEL...: 1 IN PLANT......: 0 MANE HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0 I000+ amp/volt.: 0 ------------------------------------ PLAN REVIEW SECTION ---------------------------------- Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC: ---------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ----------------------------------------------------- A. SF RESIDENTIAL--------------------------- B. COMMERCIAL------------------------------------------------------------------------------- AUDIO 8 STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: 1NTEFr-OM/PAGING: OUTDOOR LNPSC LT: BURGLAR ALARM..: OTH: :: BOILER......,..: HVAC...........: LANDSCAPE/IRRIG: X PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL NN SYSTEMS: 1 Owner: ------------------- . ---------------Contractor-- ----------------------------- TOTAL FEES:$ 5289.% RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HONES This permit is subject to the regulations contained in the 1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR Tigard Municipal Code, State of Ore. Specialty Codes and all WEST LIMN OR 97068 WEST LINN OR 97068 other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is Phone A: 557-8000 Phone N: 557-8000 not started within 180 days of issuance, or if the work is Reg NN..: 049955 suspended for more than 180 days. ATTENTION: Oregon law ----------------------------------------------------------------- requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0180. You may obtain copies of these rules or IOirect questions to OUNC by calling (503)246-1987. _.. .. -----•------------------------------------------------ REQUIRED INSPECTIONS ------------------------- Erosion 844-8444 Crawl Drain/Back Electrical Rough Insulation Insp Mechanical Final Footing Insp PLM/Underfloor Framing Insp Rain drain Insp Plumb Final Foundation Insp Mechanical Insp Shear Wall Insp Water Service In Building Final Post/Beam Strud Plumb Top Out Low Voltage Appr/Sdwlk Insp Post/Bea Mechan ectrical Servi Gas line Insp Electrical Final I s s r_r B y: Fl a r-mitt e e Si gnat u r e: ++++++ +++++++++1-+++++++++++++++-e-+++++++++++ .1 + 4 ►+-+++++-+++i-+++ 4++a-.}+++++4-+++ + Call 639-4175 by 7:00 p. m. fur an inspection needed the next business day CITY QF TIGARD DEVELOPMENT SERVICES SEWER CONNECTION PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 PERMIT #. . . . . . . : SW R99-0029 DATE ISSUED: 02/22/99 PARCEL: 2:S110BA-08100 SITE ADDRESS. . . : 11532 SW COLE LN SUBDIVISION. . . . :EVERGREEN SPRINGS ZONING: R-4. 5 BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :006 JURISDICTION: TIG TENANT NAME. . . . . : USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 0 CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1 TYPE OF USE. . . . . :SF NO. OF BUILDINGS: 1 INSTALL TYPE. . . . :L_TPSWR I MPERV SURFACE: 0 s f Remar-ks : Single family detached, Path I. Liwner-: ___.__._..__.___.__.__._.___..._...._._._..___...._.__._____._ .._.--__.__.__._.___. ...._..___._ FEES RENAISSANCE CUSTOM HOMES type amount by date recpt 1.672 SW WILLAMETTE FALLS DR PRMT $ 2300. 00 DEB 02/22/99 99-313105 WE=ST LINN OR 97068 INSP $ 35. 00 DEB 02/22/99 99-313105 Phone #: Contractor,: RENA I SSnNCE CUSTOM HOME=S 1672 WILLAMETTE FALLS DR WEST L I NN OR 97068 Phone #: 557-8000 $ 2335. 00 TOTAL_ Reg #. . : 049955 ---- - - REQUIRED INSPECTIONS --- — -This Applicant agrees to comply with all the ales and regulations Sewer- Inspection of the Unified Sewage Agency. The permit expires 188 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement _ given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-881AM18.through DAR 952-888I-8888. You may obtain copies of these r s or direct questions to OUNC by calling (583)246-1967. _ � Permittee Signature : i" ' ..� +++++++++++-F+++++++++++++++t•++t+++++++++++++•1++•+++++++++++++++++++++++++++++++++ Call 639-4175 by 7:00 p. m. for- an inspection needed the next bt_lsiness day 4+++++++++++++*+•1-++++,4-++++++++++++++++++++++++++++++++++++++++4++++++#+++++++•f++ CITY'OF TIGARD Residential Building Permit Application Plan Chec # 131.25 SW HALL BLVD. Additions or Alterations Recd Date Date Recd TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. -�' V 503-639-4171 Date to DST ! - F 503-684-7297 Permit# NYy9'eL'S Print or Type Called_ 2 Incomplete or illegible applications will not be accepted/"#,Pr` vM hE" -- – -- — -- Awa ry-ecl;�9 Name of Project Name Job t Architect Mailing Address Address Site A rens 7J6S- SW Fi Cv Q IP City/State zip Phone Name /I// rN4�,}JA,01( + CW h`oM e-s Na a t7 97Z2j 6 ZY--B'lSS Owner Mailing Address Na e/' z sW ivzl"A. h" E. ng l� Ad City/State Zip Phone Engineer Mailing Address _ _ e, n OK-9 0 557-6'300 City/State Zip Phone General Name Contractor ,; y Describe work New Addition O Alteration O Repair O Mailing Address to be done _ Prior to permit _ Additional Description or Work: issuance,a copy City/State Zip Phone of all licenses are required if Oregon Const.Cor! Board Exp Date PROJECT expired in COT Lic# I database (71(/917S VALUATION / Mechanical Name NEW CONSTRUCTION ONLY: ovc-e cl Sub- l„ l P,, C� i� Sq. Ft House: Sq Ft. Garage Contractor Mailing Address 11 Indicate the restricted energy installation by the electrical Prior to permit r 3 !v Sr�,.+6�N/ -- subcontractor_in the followin areas issuance,a copy City/State Zip Phone Restricted Audio/Stereo of all licenses C/�,,/<<,�,a,, 0,R 97I'/S `Sy- 3//S are required if Oregon Const Cont Board Exp Date Energy _ System -- Alarms expired in COT Lic# . Installations Vacuum Irrigation database _ 7 2 G Z 3 ;1'$17_9 _ �stem� System Plumbing Name _ (check all that Other: Sub- C."�f' -4 r/U'++/r•+y eppl_Y__ Contractor Mailing Address -- Corner Lot YES O Flag Lot YES [l0 7736 Sv (check one)— check one) _ �M��tv _ Has tho Subdivision Plat recorded? N/A YES NO Prior to permit City/State — Zip Phone issuance,a copyFav O/' 77omr� S Z y- +/2D —of all licenses are Oregon Const Cont. Board Exp Dale required if Lic# /' expired in COT 7 �� //vlol I hearby acknowledge that I have read this application,that the database Plumbing Lic # Exp Date information given is correct, that I am the owner or authorized agent yN P/3 /Z of the owner, and that plans submitted are in compliance with -/ Oregon State laws. — Name Signature of Owner/Agent D2at�y/99 Electrical (ja.e F�rL�'.�� Lw��1^��- _ / Sub- Mailind Address --- Contact Person Name Phone# Contractor PO f3 T„�, .! �_._L�10�s ss7 9rpor �� 1y29 __ -�--- City/State Zip Phone Prior to permit ssuance a copy C. cic�tWy`+Nj 970/5_ Gf7'IT l FOR OFFICE USE ONLY: of all licenses are Oregon Const Cont Board Fxp Date ----- required if Lic# /' Plat#: , n n Map/TL#: expired in COT 03 r; 7 y�97 I 'J d l" . f,//(69 xp D to -� �!< ---- database Electrical Lic # FSetback Zone � Solar. 3 - 1Zge- 1 -- RYI Electrical Supervisor Lic # Exp Dal Engineari IpApproval: Planning Approval: TIF lir i\dsts\forms\sfaddalt doc 11 t20/98 i I SEE 35MM ROLL# 22 FOR LARGE DOCUMENT